Individual provider Active NPI

Christian Reese, PA-C

  • Physician Assistant
  • Provo, UT
National Provider Identifier
1952091365
Registry record updated Jan 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
10254889-1206 Issued in UT
Practice address
1055 N 500 W Ste 121
Provo, UT 84604-3305
Phone
(801) 373-7350
Fax
(801) 812-5401
NPI assigned
May 9, 2023
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 2, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Physician Assistant 363A00000X 10254889-1206 UT Primary

Addresses

Primary practice location

1055 N 500 W Ste 121
Provo, UT 84604-3305

Mailing address

1055 N 500 W
Att Credentialing
Provo, UT 84604
Phone (801) 354-8225

Other practice location 1

1907 Tarleton St Apt 707
Midland, TX 79707-6651
Phone (801) 634-8794

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240203000463 UT Practitioner - Physician Assistant 0143663484 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Texas Tech University Health Science Center School of Medicine, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Revere Health PCGroup PAC ID 7517868508, 407 clinicians

Practice addresses (Care Compare)

1055 N 500
Provo, UT 84604-3305
Phone (801) 373-7350

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
10254889-1206UTMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Revere Health PC CurrentSince Mar 4, 2024 Accepting new patients
Revere Health PC CurrentSince Mar 4, 2024 Accepting new patients

Locations

1055 N 500 W
Ste 212
Provo, UT 84604
Phone (801) 374-2362

1055 N 500 W
Ste 121
Provo, UT 84604
Phone (801) 373-3750

1055 N 500 W
Provo, UT 84604
Phone (801) 429-8000

Interoperability endpoints

  • Direct secure messaging: christianreese@cuccu.allscriptsdirect.net

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1683590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704153600000",
    "number": "1952091365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1055 N 500 W",
            "address_2": "ATT CREDENTIALING",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "84604",
            "telephone_number": "801-354-8225",
            "fax_number": "801-418-0941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1055 N 500 W STE 121",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846043305",
            "telephone_number": "801-373-7350",
            "fax_number": "801-812-5401"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1907 Tarleton St Apt 707",
            "address_purpose": "LOCATION",
            "city": "Midland",
            "state": "TX",
            "postal_code": "797076651",
            "country_code": "US",
            "telephone_number": "801-634-8794",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REESE",
        "first_name": "CHRISTIAN",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-05-09",
        "last_updated": "2024-01-02",
        "certification_date": "2024-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "10254889-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Provo, UT

Sources for this page

Verify at the official NPI Registry.